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Correspondence to Professor Xavier Gómez-Batiste, The 'Qualy' Observatory/WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; [email protected]
Introduction
The timely identification of patients with advanced chronic conditions and palliative care needs (PCNs) in all settings of care is a relevant challenge of palliative care (PC).1 To respond to this challenge, several tools have been designed and validated based on the initial experience with the Gold Standards Framework.2 These originally focused on the early identification of patients with PCNs irrespective of their prognosis, preferably in the community, to gradually introduce a PC approach including a systematic needs assessment, followed by a multidimensional model of care, advance care planning, review of diseases and treatment and integrated care across the system.1 Additionally, this might be useful to identify patients with a limited life prognosis as a relevant aspect to help patients, relatives and professionals with decision-making, and emphasise some of the elements of care, such as advanced care planning, spiritual needs assessment, bereavement and end-of-life (EoL) decisions.
Clinical prediction of survival (CPS) is the most used trigger for the identification of patients at the EoL, even though several systematic reviews (SRs) have highlighted clinicians' limitations for distinguishing patients who have a limited life prognosis.3–5 Furthermore, prognostic tools have been published for advanced chronic diseases, although most have been validated for a specific clinical condition or care setting, or include variables that are not necessarily easy to obtain in daily practice.6 7 All of the above emphasises the need to provide clinicians with feasible and reliable tools to use in daily practice that take into account a necessary and cautious approach of applying prognostic risks of selected populations to individual patients.
Regarding this, the NECesidades PALiativas (NECPAL) CCOMS-ICO V.3.1 2017 tool which is a validated instrument based on the Prognostic Indicator Guidance of the Gold Standards Framework8 and the Supportive and Palliative Care Indicators Tool9 that provides a comprehensive assessment and can be used to screen and identify people with PCNs, create a checklist of needs through a multidimensional assessment and identify mortality risk factors in all areas of the healthcare system was used.10 It consists of a multifactorial, non-dichotomous assessment...